Provider Demographics
NPI:1023120979
Name:EDEN, ELINOR
Entity type:Individual
Prefix:DR
First Name:ELINOR
Middle Name:
Last Name:EDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 NOVAK TER
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1677
Mailing Address - Country:US
Mailing Address - Phone:301-596-5535
Mailing Address - Fax:301-421-0010
Practice Address - Street 1:10715 CHARTER DRIVE
Practice Address - Street 2:SUITE 270
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2871
Practice Address - Country:US
Practice Address - Phone:301-596-5535
Practice Address - Fax:301-421-0010
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01729103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
767RMedicare ID - Type Unspecified